BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1361
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|AUTHOR: |Nielsen |
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|VERSION: |February 19, 2016 |
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|HEARING DATE: |April 13, 2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Medi-Cal: eyeglasses
SUMMARY :1. Provides Medi-Cal coverage of one pair of eyeglasses provided
every two years for an individual who is 21 years of age or
older and who is unable to meet or exceed the driver's license
vision standards established by the Department of Motor
Vehicles.
Existing law:
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS) and under which
qualified low-income persons receive health care benefits.
2)Establishes a schedule of benefits under the Medi-Cal program.
Excludes specified optional benefits from coverage under the
Medi-Cal program, including optometric and optician services,
including services provided by a fabricating optical
laboratory, except for beneficiaries under the Early and
Periodic Screening Diagnosis and Treatment Program
(individuals under age 21), and beneficiaries receiving
long-term care in a nursing facility that is a skilled nursing
facility or intermediate care facility that is licensed as a
nursing facility. Optometry services in Medi-Cal were
reinstated (eye exams and procedures by optometrist) for
adults 21 and over in July 2010.
3)Prohibits the Department of Motor Vehicles (DMV) from issuing
or renewing a driver's license to any person whose best
corrected visual acuity is 20/200 or worse in that person's
better eye, as verified by an optometrist or ophthalmologist.
This bill:
1)Provides Medi-Cal coverage of one pair of eyeglasses provided
every two years for a Medi-Cal eligible individual who is 21
SB 1361 (Nielsen) Page 2 of ?
years of age or older and who is unable to meet or exceed the
driver's license vision standards established by DMV.
2)Permits DHCS to seek approval of any necessary state plan
amendments to implement this bill,
3)Implements this bill only to the extent that federal financial
participation is available and any necessary federal approvals
have been obtained.
4)Permits DHCS to implement this section by means of all-county
letters, provider bulletins, or similar instructions, without
taking further regulatory action.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, many low income
Californians in need of eyeglasses lack the money to buy them.
Working Californians who have impaired vision are not able to
fulfill their job duties effectively or safely. Californians
who failed the DMV's vision exam struggle each time they
drive. Restoring this service will keep people safer on the
road. Adults who are striving to go back to school or college
are not able to see well in class and will perform beneath
their capabilities. By restoring Medi-Cal's coverage for one
pair of eyeglasses every two years, Californians can get back
to work or school and be able to drive safely. People who are
on the Medi-Cal system often do not have the financial
resources to meet basic needs. According to Dr. Karrin Vallin,
the majority of her low-income patients come in for exams but
they simply do not have the money to purchase glasses for
themselves, and it is a low priority over the needs of their
children. By restoring the coverage of eyeglasses, low income
individuals will be encouraged to visit their optometrists
more regularly. Eye exams can detect a number of ocular and
systemic diseases such as glaucoma, diabetes and hypertension.
Early detection of such illnesses can reduce cost to our
overall health system. Often patients are discouraged from
getting an exam, knowing they can't get glasses.
SB 1361 (Nielsen) Page 3 of ?
2)Medicaid optional and mandatory benefits. States establish and
administer their own Medicaid programs and determine the type,
amount, duration, and scope of services within broad federal
guidelines. States are required to cover certain "mandatory
benefits," and can choose to provide other "optional benefits"
through the Medicaid program, for which they can receive
federal financial participation (federal "matching funds").
The federal Centers for Medicare and Medicaid Services
indicates the following are mandatory and optional benefits in
Medicaid:
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| | |
| Mandatory Benefits | Optional Benefits |
| | |
|--------------------------+-------------------------------------|
| | |
| Inpatient | Prescription drugs |
| hospital services | |
| | |
| | Clinic services |
| Outpatient | |
| hospital services | |
| | Physical therapy |
| | |
| Early and | |
| Periodic Screening, | Occupational therapy |
| Diagnostic, and | |
| Treatment Services | |
| (EPSDT). | Speech, hearing and language |
| | disorder services |
| | |
| Nursing facility | |
| services | Respiratory care services |
| | |
| | |
| Home health | Other diagnostic, screening, |
| services | preventive and rehabilitative |
| | services |
| | |
| Physician | |
| services | Podiatry services |
| | |
| | |
SB 1361 (Nielsen) Page 4 of ?
| Rural health | Optometry services |
| clinic services | |
| | |
| | Dental services |
| Federally | |
| qualified health | |
| center services | Dentures |
| | |
| | |
| Laboratory and | Prosthetics |
| X-ray services | |
| | |
| | Eyeglasses |
| Family planning | |
| services | |
| | Chiropractic services |
| | |
| Nurse Midwife | |
| services | Other practitioner services |
| | |
| | |
| Certified | Private duty nursing |
| Pediatric and Family | services |
| Nurse Practitioner | |
| services | |
| | Personal Care |
| | |
| Freestanding | |
| Birth Center | Hospice |
| services (when | |
| licensed or | |
| otherwise recognized | Case management |
| by the state) | |
| | |
| | Services for individuals age |
| Transportation to | 65 or older in an Institution |
| medical care | for Mental Disease (IMD) |
| | |
| | |
| Tobacco cessation | Services in an intermediate |
| counseling for | care facility for the mentally |
| pregnant women | retarded |
| | |
| | |
| | State Plan Home and |
SB 1361 (Nielsen) Page 5 of ?
| | Community-Based Services - |
| | 1915(i) |
| | |
| | |
| | Self-Directed Personal |
| | Assistance Services - 1915(j) |
| | |
| | |
| | Community First Choice |
| | Option - 1915(k) |
| | |
| | |
| | Tuberculosis Related |
| | Services |
| | |
| | |
| | Inpatient psychiatric |
| | services for individuals under |
| | age 21 |
| | |
| | |
| | Other services approved by |
| |the Secretary* |
| | |
| | |
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*This includes services furnished in a religious non-medical
health care institution, emergency hospital services by a
non-Medicare certified hospital, and critical access hospital.
1)Background on Medi-Cal optional benefit elimination. In 2009,
the Legislature and Governor enacted AB 5 (Committee on
Budget, Chapter 20, Statutes of 2009), which eliminated some
optional benefits for adults that had been covered under
Medi-Cal. Optional benefits eliminated by AB 5 were
acupuncture services, audiology and speech therapy services,
chiropractic services, optometric and optician services,
including services provided by a fabricating optical
laboratory, podiatric services, psychology services, and
incontinence creams and washes. When the state eliminated
optional benefits, services that were previously provided by
an acupuncturist, podiatrist, a psychologist, which are no
longer covered by Medi-Cal can still be provided by a
physician. DHCS indicates its optional benefit exclusion
SB 1361 (Nielsen) Page 6 of ?
policy also allows certain populations (pregnant women and
beneficiaries under 21 years old) to continue to receive these
optional services. DHCS also indicates all Medi-Cal eligible
beneficiaries can access optional benefit services in certain
settings, such as hospital outpatient departments or emergency
rooms, and some optional services (such as podiatry and
chiropractic services) can be received in Federally Qualified
Health Centers (FQHCs) and Rural Health Clinics (RHCs).
Most of the General Fund savings from the optional benefit
elimination in AB 5 resulted from the elimination of adult
dental. Litigation brought by RHCs resulted in podiatry and
other services being reinstated at RHCs and FQHCs. Optometry
services were reinstated (eye exams and procedures by
optometrist) to adults 21 and over in July 2010, but all eye
appliances (glasses, contact lenses, low vision devices) and
dispensing optician services, including services provided by
fabricating optical laboratories for adults 21 and over, are
still excluded from coverage. Psychology services were
reinstated in January 1, 2014, and last session, the
Legislature and Governor reinstated some adult dental services
in AB 82 (Budget Committee, Chapter 23, Statutes of 2013), the
2013-14 budget health trailer bill. The Legislative Analyst's
Office estimates the General Savings from the elimination of
the optician/optical lab services benefit in Medi-Cal is $4.9
million in 2015-16.
2)Prior legislation. AB 1868 (Gomez of 2013), would have
provided Medi-Cal coverage of medical and surgical services
provided by a podiatrist within his or her scope of practice
that, if provided by a physician, would be considered
physician services, for services which can be provided by
either a physician or a podiatrist. AB 1868 was held on the
Senate Appropriations Committee suspense file.
3)Support. This bill is supported by VSP Global and the
California Optometric Association (COA). COA argues a recent
study by Ingenix Consulting shows individuals with eyeglass
coverage are at least two times more likely to receive a
comprehensive eye exam compared to those who do not have
eyeglass coverage. Restoring the eyeglass benefit for adults
in the Medi-Cal program means they would be more likely to
receive an eye exam, which often leads to early diagnosis of
diabetes, heart disease and high blood pressure - major cost
drivers in California's health care system. Early diagnosis
SB 1361 (Nielsen) Page 7 of ?
means lower treatment cost for these conditions and better
patient outcomes. COA states eye care is a small fraction of
the health care market with a far-reaching impact because if
someone cannot see, he/she will have a more difficult time
finding work, driving, cooking, and ultimately have a higher
chance of disability. A study found that individuals with
vision problems are more likely to experience social isolation
and a greater tendency to have other health problems. A pair
of eyeglasses can make all the difference in helping
individuals to regain their confidence and live independently.
As the aging population rapidly grows, vision problems and
eye-related diseases are expected to double.
4)Policy questions.
a) In 2014-15, the Senate version of the budget proposed to
restore the optional benefits eliminated in 2009, but this
proposal was not included in the final budget agreement.
Several optional benefits eliminated by AB 5 have since
been restored, but other important benefits, including
podiatry and glasses and contact lenses, have not been.
Which Medi-Cal optional benefits should be restored?
b) This bill would restore Medi-Cal coverage of one pair of
eyeglasses provided every two years for an individual who
is 21 years of age or older and who is unable to meet or
exceed the driver's license vision standards established by
DMV. The DMV's vision screening standard is the ability to
see 20/40 with both eyes together, with or without
corrective lenses. Individuals with extremely poor vision
(visual acuity of 20/200 or worse), may not be scheduled
for a drive test. Existing Medi-Cal regulations already
contain a vision standard which makes it easier for
beneficiaries to obtain glasses. One proponent of this bill
(an optometrist) explains the rationale for the standard in
this bill is the previous Medi-Cal adult vision standard
resulted in people with lessor vision prescription needs
being eligible, but who do not really need a correction.
Should this vision benefit restoration be limited to
individuals who meet this DMV vision standard or should the
current Medi-Cal standard apply?
SUPPORT AND OPPOSITION :
Support: American Federation of State, County and Municipal
Employees, AFL-CIO
Association of California Healthcare Districts
SB 1361 (Nielsen) Page 8 of ?
California Optometric Association
County Health Executives Association of California
National Association of Social Workers-California
Chapter
VSP Global, Inc.
Western Center on Law & Poverty
An individual
Oppose: None received
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